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Sever ML, Calatroni A, Roberts G, du Toit G, Bahnson HT, Radulovic S, Larson D, Byron M, Santos AF, Huffaker MF, Wheatley LM, Lack G. Developing a Prediction Model for Determination of Peanut Allergy Status in the Learning Early About Peanut Allergy (LEAP) Studies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2217-2227.e9. [PMID: 37146884 DOI: 10.1016/j.jaip.2023.04.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/09/2023] [Accepted: 04/12/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND The Learning Early About Peanut Allergy (LEAP) study team developed a protocol-specific algorithm using dietary history, peanut-specific IgE, and skin prick test (SPT) to determine peanut allergy status if the oral food challenge (OFC) could not be administered or did not provide a determinant result. OBJECTIVE To investigate how well the algorithm determined allergy status in LEAP; to develop a new prediction model to determine peanut allergy status when OFC results are not available in LEAP Trio, a follow-up study of LEAP participants and their families; and to compare the new prediction model with the algorithm. METHODS The algorithm was developed for the LEAP protocol before the analysis of the primary outcome. Subsequently, a prediction model was developed using logistic regression. RESULTS Using the protocol-specified algorithm, 73% (453/617) of allergy determinations matched the OFC, 0.6% (4/617) were mismatched, and 26% (160/617) participants were nonevaluable. The prediction model included SPT, peanut-specific IgE, Ara h 1, Ara h 2, and Ara h 3. The model inaccurately predicted 1 of 266 participants as allergic who were not allergic by OFC and 8 of 57 participants as not allergic who were allergic by OFC. The overall error rate was 9 of 323 (2.8%) with an area under the curve of 0.99. The prediction model additionally performed well in an external validation cohort. CONCLUSION The prediction model performed with high sensitivity and accuracy, eliminated the problem of nonevaluable outcomes, and can be used to estimate peanut allergy status in the LEAP Trio study when OFC is not available.
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Affiliation(s)
- Michelle L Sever
- PPD Government and Public Health Services, Morrisville, NC; Rho Federal Systems Division, Durham, NC
| | | | - Graham Roberts
- University of Southampton and Southampton NIHR Biomedical Research Centre, Southampton, United Kingdom; David Hide Centre, Isle of Wight, United Kingdom
| | - George du Toit
- Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, London, United Kingdom; Pediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Henry T Bahnson
- The Immune Tolerance Network, Benaroya Research Institute at Virginia Mason, Seattle, Wash
| | - Suzana Radulovic
- Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, London, United Kingdom; Pediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | - Alexandra F Santos
- Department of Pediatric Allergy, School of Life Course Sciences, King's College London and Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Michelle F Huffaker
- Immune Tolerance Network, University of California San Francisco, San Francisco, Calf.
| | - Lisa M Wheatley
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Gideon Lack
- Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, London, United Kingdom; Pediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Pascal M, Kamath SD, Faber M. Diagnosis and Management of Shellfish Allergy: Current Approach and Future Needs. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0186-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Lee D, Kim HS, Shin E, Do SG, Lee CK, Kim YM, Lee MB, Min KY, Koo J, Kim SJ, Nam ST, Kim HW, Park YH, Choi WS. Polysaccharide isolated from Aloe vera gel suppresses ovalbumin-induced food allergy through inhibition of Th2 immunity in mice. Biomed Pharmacother 2018; 101:201-210. [PMID: 29494957 DOI: 10.1016/j.biopha.2018.02.061] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/09/2018] [Accepted: 02/15/2018] [Indexed: 12/15/2022] Open
Abstract
An allergic reaction occurs when the immune system overreacts to harmless substance called allergen that gains access to the body. Food allergy is a hypersensitive immune reaction to food proteins and the number of patients with food allergy has recently increased. Aloe Vera is used for wellness and medicinal purposes. In particular, Aloe vera has been reported to enhance immunity. However, the effect of Aloe vera on food allergy is not yet known. In this study, we investigated the effects of processed Aloe vera gel (PAG) containing low molecular weight Aloe polysaccharide (AP) on ovalbumin (OVA)-induced food allergy in mice. Allergic symptoms, rectal temperature, and diarrhea were measured in OVA-induced food allergy mice. Other allergic parameters were also analyzed by RT-PCR, ELISA, flow cytometry, and other biochemical methods. As the results, PAG suppressed the decrease of body temperature, diarrhea, and allergic symptoms in OVA-induced food allergy mice. PAG also reduced serum concentrations of type 2 helper T cell (Th2) cytokines (Interleukin-(IL)-4, IL-5, and IL-13) as well as histamine, mast cell protease-1 (MCP-1), and immunoglobulin (Ig)E. PAG blocked the degranulation of mast cells and infiltration of eosinophils in intestine. Furthermore, PAG suppressed the population of Th2 cells in spleen and mesenteric lymph nodes. PAG also increased the production of IL-10 and population of type 1 regulatory T (Tr1) cells in mice with food allergy. Taken together, our findings suggest that PAG suppressed Th2 immune responses through, at least partially, stimulating the secretion of IL-10 in food allergy mice.
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Affiliation(s)
- Dajeong Lee
- Department of Immunology, College of Medicine, Konkuk University, Chungju 27478, Republic of Korea
| | - Hyuk Soon Kim
- Department of Immunology, College of Medicine, Konkuk University, Chungju 27478, Republic of Korea
| | - Eunju Shin
- Univera Inc., Seoul 04782, Republic of Korea
| | - Seon-Gil Do
- Univera Inc., Seoul 04782, Republic of Korea
| | - Chong-Kil Lee
- College of Pharmacy, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Young Mi Kim
- College of Pharmacy, Duksung Women's University, Seoul 01369, Republic of Korea
| | - Min Bum Lee
- Department of Immunology, College of Medicine, Konkuk University, Chungju 27478, Republic of Korea
| | - Keun Young Min
- Department of Immunology, College of Medicine, Konkuk University, Chungju 27478, Republic of Korea
| | - Jimo Koo
- Department of Immunology, College of Medicine, Konkuk University, Chungju 27478, Republic of Korea
| | - Su Jeong Kim
- Department of Immunology, College of Medicine, Konkuk University, Chungju 27478, Republic of Korea
| | - Seung Taek Nam
- Department of Immunology, College of Medicine, Konkuk University, Chungju 27478, Republic of Korea
| | - Hyun Woo Kim
- Department of Immunology, College of Medicine, Konkuk University, Chungju 27478, Republic of Korea
| | - Young Hwan Park
- Department of Immunology, College of Medicine, Konkuk University, Chungju 27478, Republic of Korea
| | - Wahn Soo Choi
- Department of Immunology, College of Medicine, Konkuk University, Chungju 27478, Republic of Korea.
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4
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Ali A, Weiss TR, McKee D, Scherban A, Khan S, Fields MR, Apollo D, Mehal WZ. Efficacy of individualised diets in patients with irritable bowel syndrome: a randomised controlled trial. BMJ Open Gastroenterol 2017; 4:e000164. [PMID: 29018540 PMCID: PMC5628288 DOI: 10.1136/bmjgast-2017-000164] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 07/26/2017] [Accepted: 08/18/2017] [Indexed: 12/12/2022] Open
Abstract
Background Patients with irritable bowel syndrome (IBS) are often placed on diets guided by food intolerance assays, although these have not been validated. We assessed the effects of individualised diets in patients with IBS guided by a leucocyte activation test. Methods This is a parallel-group, double-blind, randomised controlled trial of 58 adults with IBS seen at an academic health centre in Northeast USA. Peripheral venous blood was analysed using a leucocyte activation test; individual foods were reported to produce positive or negative results. Participants were randomised to a 4-week diet with either individualised guidance to eliminate foods with positive assay results and allow foods with negative assay results (intervention), or with individualised guidance, matched in rigour and complexity, to eliminate foods with negative assay results and allow foods with positive assay results (comparison). The primary outcome was between-group differences in the IBS Global Improvement Scale (GIS). Secondary outcomes included reductions in IBS Symptom Severity Scale (SSS) scores and increases in IBS Adequate Relief (AR) and Quality of Life (QOL) scores. An aptamer-based proteomic analysis was conducted in strong responders. Results The intervention group had significantly greater increases in mean GIS score after 4 weeks (0.86 vs comparison; 95% CI 0.05 to 1.67; p=0.04) and 8 weeks (1.22 vs comparison; 95% CI 0.22 to 2.22; p=0.02). The intervention group also had significantly greater reductions in mean SSS score at 4 weeks (–61.78 vs comparison; 95% CI –4.43 to –119.14; p=0.04) and 8 weeks (–66.42 vs comparison; 95% CI –5.75 to –127.09; p=0.03). There were no significant differences between intervention and comparison groups in mean AR or QOL scores. A reduction in neutrophil elastase concentration was associated with reduced symptoms. Conclusions Elimination diets guided by leucocyte activation tests reduced symptoms. These findings could lead to insights into the pathophysiology of IBS. Trial registration number NCT02186743.
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Affiliation(s)
- Ather Ali
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Theresa R Weiss
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Douglas McKee
- Department of Economics, Cornell University, Ithaca, New York, USA
| | - Alisa Scherban
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Sumiya Khan
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Maxine R Fields
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Damian Apollo
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Wajahat Z Mehal
- School of Medicine, Yale University, New Haven, Connecticut, USA
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Pedrosa M, Boyano-Martínez T, García-Ara C, Quirce S. Shellfish Allergy: a Comprehensive Review. Clin Rev Allergy Immunol 2016; 49:203-16. [PMID: 24870065 DOI: 10.1007/s12016-014-8429-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Shellfish allergy is of increasing concern, as its prevalence has risen in recent years. Many advances have been made in allergen characterization. B cell epitopes in the major allergen tropomyosin have been characterized. In addition to tropomyosin, arginine kinase, sarcoplasmic calcium-binding protein, and myosin light chain have recently been reported in shellfish. All are proteins that play a role in muscular contraction. Additional allergens such as hemocyanin have also been described. The effect of processing methods on these allergens has been studied, revealing thermal stability and resistance to peptic digestion in some cases. Modifications after Maillard reactions have also been addressed, although in some cases with conflicting results. In recent years, new hypoallergenic molecules have been developed, which constitute a new therapeutic approach to allergic disorders. A recombinant hypoallergenic tropomyosin has been developed, which opens a new avenue in the treatment of shellfish allergy. Cross-reactivity with species that are not closely related is common in shellfish-allergic patients, as many of shellfish allergens are widely distributed panallergens in invertebrates. Cross-reactivity with house dust mites is well known, but other species can also be involved in this phenomenon.
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Affiliation(s)
- María Pedrosa
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Teresa Boyano-Martínez
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Carmen García-Ara
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Santiago Quirce
- Allergy Department, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
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Scientific Opinion on the evaluation of allergenic foods and food ingredients for labelling purposes. EFSA J 2014. [DOI: 10.2903/j.efsa.2014.3894] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Wang W, Qi C, Kang TF, Niu Y, Jin G, Ge YQ, Chen Y. Analysis of the Interaction between Tropomyosin Allergens and Antibodies Using a Biosensor Based on Imaging Ellipsometry. Anal Chem 2013; 85:4446-52. [PMID: 23517013 DOI: 10.1021/ac303783j] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Wei Wang
- Agro-product Safety Research
Center, Chinese Academy of Inspection and Quarantine, #3, Gaobeidian North Rd., Beijing 100123, China
- College of Food Science & Nutritional Engineering, China Agricultural University, Beijing 100083, China
| | - Cai Qi
- Agro-product Safety Research
Center, Chinese Academy of Inspection and Quarantine, #3, Gaobeidian North Rd., Beijing 100123, China
- Institute
of Equipment Technology, Chinese Academy of Inspection and Quarantine, #3, Gaobeidian
North Rd., Beijing 100123, China
| | - Teng-fei Kang
- Institute of Mechanics, Chinese Academy of Sciences, #15, Beisihuan West Rd.,
Beijing 100190, China
| | - Yu Niu
- Institute of Mechanics, Chinese Academy of Sciences, #15, Beisihuan West Rd.,
Beijing 100190, China
| | - Gang Jin
- Institute of Mechanics, Chinese Academy of Sciences, #15, Beisihuan West Rd.,
Beijing 100190, China
| | - Yi-qiang Ge
- College of Food Science & Nutritional Engineering, China Agricultural University, Beijing 100083, China
- China Rural Technology Development Center, Beijing 100045, China
| | - Ying Chen
- Agro-product Safety Research
Center, Chinese Academy of Inspection and Quarantine, #3, Gaobeidian North Rd., Beijing 100123, China
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Abdel Rahman AM, Kamath SD, Gagné S, Lopata AL, Helleur R. Comprehensive proteomics approach in characterizing and quantifying allergenic proteins from northern shrimp: toward better occupational asthma prevention. J Proteome Res 2013; 12:647-56. [PMID: 23268739 DOI: 10.1021/pr300755p] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Occupational asthma is a major chronic health dilemma among workers involved in the seafood industry. Several proteins notoriously known to cause asthma have been reported in different seafood. This work involves the application of an allergenomics strategy to study the most potent allergens of northern shrimp. The proteins were extracted from shrimp tissue and profiled by gel electrophoresis. Allergenic proteins were identified based on their reactivity to patient sera and were structurally identified using tandem mass spectrometry. Northern shrimp tropomyosin, arginine kinase, and sarcoplasmic calcium-binding protein were found to be the most significant allergens. Multiple proteolytic enzymes enabled 100% coverage of the sequence of shrimp tropomyosin by tandem mass specrometry. Only partial sequence coverage was obtained, however, for the shrimp allergen arginine kinase. Signature peptides, for both tropomyosin and arginine kinase, were assigned and synthesized for use in developing the multiple reaction monitoring tandem mass spectrometric method. Subsequently, air samples were collected from a shrimp processing plant and two aerosolized proteins quantified using tandem mass specrometry. Allergens were detected in all areas of the plant, reaching levels as high as 375 and 480 ng/m(3) for tropomyosine and arginine kinase, respectively. Tropomyosine is much more abundant than arginine kinase in shrimp tissues, so the high levels of arginine kinase suggest it is more easily aerosolized. The present study shows that mass spectrometric analysis is a sensitive and accurate tool in identifying and quantifying aerosolized allergens.
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Affiliation(s)
- Anas M Abdel Rahman
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
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9
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Liu GM, Li B, Yu HL, Cao MJ, Cai QF, Lin JW, Su WJ. Induction of mud crab (Scylla paramamosain) tropomyosin and arginine kinase specific hypersensitivity in BALB/c mice. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2012; 92:232-238. [PMID: 21780134 DOI: 10.1002/jsfa.4565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 06/15/2011] [Accepted: 06/16/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND Shellfish hypersensitivity is among the most common food allergies. The allergens tropomyosin (TM) and arginine kinase (AK) from mud crab (Scylla paramamosain) were purified to homogeneity. BALB/c female mice were sensitized with TM and AK by intragastric administration. Mice treated with normal saline served as the negative control (NC) group. RESULTS Compared with NC group, mice that were treated with TM and AK developed reduced activity; meanwhile, their scratching behavior and specific-IgE level were increased. Specific-CD4 + T cells were significantly elevated in the splenocyte cultures of the mice upon TM and AK stimulation. However, compared with the positive control group (ovalbumin, OVA), there was no significant difference. The expression of IL-4 in culture cells stimulated by TM, AK, and OVA group showed significant differences from the NC group, respectively. CONCLUSION These results indicated that a BALB/c mouse model for sensitization to TM and AK from mud crab was successfully established, and the Th2 response was observed, displaying increased immunoglobulin E levels, together with the production of interleukin 4 and allergic symptoms.
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Affiliation(s)
- Guang-Ming Liu
- College of Biological Engineering, Jimei University, Xiamen, Fujian 361021, China
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Katiraei P, Bultron G. Need for a comprehensive medical approach to the neuro-immuno-gastroenterology of irritable bowel syndrome. World J Gastroenterol 2011; 17:2791-800. [PMID: 21734786 PMCID: PMC3120938 DOI: 10.3748/wjg.v17.i23.2791] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 03/08/2011] [Accepted: 03/15/2011] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is defined by the Rome III criteria as symptoms of recurrent abdominal pain or discomfort with the onset of a marked change in bowel habits with no evidence of an inflammatory, anatomic, metabolic, or neoplastic process. As such, many clinicians regard IBS as a central nervous system problem of altered pain perception. Here, we review the recent literature and discuss the evidence that supports an organic based model, which views IBS as a complex, heterogeneous, inter-dependent, and multi-variable inflammatory process along the neuronal-gut axis. We delineate the organic pathophysiology of IBS, demonstrate the role of inflammation in IBS, review the possible differences between adult and pediatric IBS, discuss the merits of a comprehensive treatment model as taught by the Institute of Functional Medicine, and describe the potential for future research for this syndrome.
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Sato S, Tachimoto H, Shukuya A, Ogata M, Komata T, Imai T, Tomikawa M, Ebisawa M. Utility of the peripheral blood basophil histamine release test in the diagnosis of hen's egg, cow's milk, and wheat allergy in children. Int Arch Allergy Immunol 2011; 155 Suppl 1:96-103. [PMID: 21646803 DOI: 10.1159/000327490] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The diagnosis of food allergy (FA) is made by oral food challenge tests (OFCs) that occasionally produce serious symptoms in patients; therefore, whether to perform OFCs should be carefully considered. The utility of the histamine release test (HRT) in the diagnosis of childhood FA has not been fully examined. METHODS Sixty-four subjects with suspected hen's egg allergy, cow's milk allergy (CMA), and wheat allergy (WA) were enrolled. The diagnosis of FA was made based on the outcomes of OFCs or a convincing history of symptoms after food ingestion within 6 months before or after sample collection. HRT was performed using an HRT Shionogi kit. The threshold of histamine release (HRT threshold), which was defined as the minimum concentration of food antigen to induce a 10% net histamine release, was analyzed in association with FA diagnosis. RESULTS Receiver operating characteristic analysis showed that the HRT threshold was useful in the diagnosis of heated egg allergy (HEA), raw egg allergy (REA), CMA, and WA. We were able to determine the cutoff value for the HRT threshold in relation to outcomes of OFCs. The cutoff value was 6 ng/ml of egg white antigen in HEA and REA (p < 0.01), 40 ng/ml of milk antigen in CMA (p < 0.01), and 500 ng/ml of wheat antigen in WA (p < 0.05). The efficiency was 70.3% for HEA, 78.0% for REA, 77.6% for CMA, and 70.7% for WA. CONCLUSIONS We conclude that the HRT threshold measurement for egg white, milk, and wheat antigen is related to outcomes of OFCs and is useful in determining when OFCs should be performed.
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Affiliation(s)
- Sakura Sato
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan
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Abstract
BACKGROUND Food allergy is increasingly common; however, there is a discrepancy between the large number of people who believe they or their children are affected and the actual number with true food allergies. It is therefore imperative that physicians evaluating patients with possible adverse reactions to foods understand the current modalities used to diagnose food allergies. METHODS Simple tests including skin-prick testing (SPT) and serum food-specific IgE testing are the most commonly used diagnostic tests to evaluate for IgE-mediated food reactions. However, these tests have pitfalls and their usefulness must be appreciated to avoid over- and underdiagnosis. RESULTS A firm diagnosis is imperative because a misdiagnosis could lead to life-threatening reactions and overdiagnosis will lead to unnecessary elimination diets with nutritional and social implications. Physician-supervised oral food challenges (OFC) remain the gold standard for food allergy diagnosis; however, a careful medical history and simple tests can often provide a reliable diagnosis. CONCLUSION In this review, we examine the usefulness and pitfalls of SPT used by allergists and serum food-specific IgE levels that are available to all practitioners. We also review the OFC as a diagnostic modality in food allergy. Finally, we describe emerging tests, such as the basophil activation test, atopy patch testing, and component-resolved diagnostics, that may be of benefit in the future.
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Affiliation(s)
- Jay A Lieberman
- Division of Allergy and Immunology, Department of Pediatrics, Elliot and Roslyn Jaffe Food Allergy Institute, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA.
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Diagnosis of Food Allergy: Epicutaneous Skin Tests, In Vitro Tests, and Oral Food Challenge. Curr Allergy Asthma Rep 2010; 11:58-64. [DOI: 10.1007/s11882-010-0149-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Seafood plays an important role in human nutrition and health. The growing international trade in seafood species and products has added to the popularity and frequency of consumption of a variety of seafood products across many countries. This increased production and consumption of seafood has been accompanied by more frequent reports of adverse health problems among consumers as well as processors of seafood. Adverse reactions to seafood are often generated by contaminants but can also be mediated by the immune system and cause allergies. These reactions can result from exposure to the seafood itself or various non-seafood components in the product. Non-immunological reactions to seafood can be triggered by contaminants such as parasites, bacteria, viruses, marine toxins and biogenic amines. Ingredients added during processing and canning of seafood can also cause adverse reactions. Importantly all these substances are able to trigger symptoms which are similar to true allergic reactions, which are mediated by antibodies produced by the immune system against specific allergens. Allergic reactions to 'shellfish', which comprises the groups of crustaceans and molluscs, can generate clinical symptoms ranging from mild urticaria and oral allergy syndrome to life-threatening anaphylactic reactions. The prevalence of crustacean allergy seems to vary largely between geographical locations, most probably as a result of the availability of seafood. The major shellfish allergen is tropomyosin, although other allergens may play an important part in allergenicity such as arginine kinase and myosin light chain. Current observations regard tropomyosin to be the major allergen responsible for molecular and clinical cross-reactivity between crustaceans and molluscs, but also to other inhaled invertebrates such as house dust mites and insects. Future research on the molecular structure of tropomyosins with a focus on the immunological and particularly clinical cross-reactivity will improve diagnosis and management of this potentially life-threatening allergy and is essential for future immunotherapy.
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Affiliation(s)
- A L Lopata
- RMIT University, Allergy Research Group, Bundoora West Campus, Melbourne, Vic., Australia.
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Effective Allergy Practice: A Document on Standards of Care and Management for the Allergy Patient: British Society for Allergy and Environmental Medicine with the British Society for Nutritional Medicine Subcommittee on Allergy Practice. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/13590849509008764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Maberly DJ, Anthony HM. Asthma Management in a ‘Clean’ Environment: 2. Progress and Outcome in a Cohort of Patients. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/13590849208997979] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. ACTA ACUST UNITED AC 2009; 109:1204-14. [PMID: 19559137 DOI: 10.1016/j.jada.2009.04.012] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 02/04/2009] [Indexed: 12/17/2022]
Abstract
This review summarizes what is known about the effect of diet on irritable bowel syndrome (IBS) symptoms emphasizing data from randomized, controlled clinical trials. Studies suggest that IBS symptoms in one quarter of patients may be caused or exacerbated by one or more dietary components. Recent studies indicate that a diet restricted in fermentable, poorly absorbed carbohydrates, including fructose, fructans (present in wheat and onions), sorbitol, and other sugar alcohols is beneficial, but confirmatory studies are needed. Despite a long history of enthusiastic use, fiber is marginally beneficial. Insoluble fiber may worsen symptoms. Some patients with IBS, especially those with constipation, will improve with increased intake of soluble fiber. Prebiotic fibers have not been adequately tested. Daily use of peppermint oil is effective in relieving IBS symptoms. The usefulness of probiotics in the form of foods such as live-culture yogurt and buttermilk for IBS symptoms is not established. In clinical practice, it is very difficult to establish that a patient's symptoms result from an adverse reaction to food. A double blind placebo-controlled food challenge is the most reliable method, but it is not suitable for routine clinical use. A modified exclusion diet and stepwise reintroduction of foods or trials of eliminating classes of food may be useful.
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Affiliation(s)
- William D Heizer
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, USA.
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Boulay A, Houghton J, Gancheva V, Sterk Y, Strada A, Schlegel-Zawadzka M, Sora B, Sala R, van Ree R, Rowe G. A EuroPrevall review of factors affecting incidence of peanut allergy: priorities for research and policy. Allergy 2008; 63:797-809. [PMID: 18588545 DOI: 10.1111/j.1398-9995.2008.01776.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Peanuts are extensively cultivated around the world, providing a foodstuff that is both cheap to produce and nutritious. However, allergy to peanuts is of growing global concern, particularly given the severity of peanut-allergic reactions, which can include anaphylaxis and death. Consequently, it is important to understand the factors related to the prevalence of peanut allergy in order to inform efforts to ameliorate or pre-empt the condition. In this article we review evidence for the relevance of factors hypothesized to have some association with allergy prevalence, including both genetic and environmental factors. Although our analysis does indicate some empirical support for the importance of a number of factors, the key finding is that there are significant data gaps in the literature that undermine our ability to provide firm conclusions. We highlight these gaps, indicating questions that need to be addressed by future research.
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Affiliation(s)
- A Boulay
- Institute of Food Research, Norwich Research Park, Colney, Norwich, UK
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20
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Uz E, Türkay C, Aytac S, Bavbek N. Risk factors for irritable bowel syndrome in Turkish population: role of food allergy. J Clin Gastroenterol 2007; 41:380-3. [PMID: 17413606 DOI: 10.1097/01.mcg.0000225589.70706.24] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
GOALS The aim of this study was to determine the prevalence of food hypersensitivity in Turkish patients with irritable bowel syndrome (IBS). BACKGROUND The IBS is a chronic disease of the gastrointestinal tract characterized by abdominal pain, distension, meteorism and either diarrhea or constipation. The role of diet in the pathogenesis of IBS remains controversial. Many investigators have shown that individual foods can trigger symptoms in some patients; nevertheless, the percentage of patients that benefit from dietary manipulation ranges from 15% to 67% in different reports. STUDY Skin prick test to 11 common allergens, total IgE, eosinophilic cationic protein and eosinophil counts were evaluated in 100 patients satisfying the Rome II criteria and compared with 25 healthy controls. The history and physical examination of the groups were recorded and Beck Depression and Anxiety Inventories were performed. RESULTS One hundred patients were entered into the study with a mean age of 45.63+/-12.91 years. Of the patients 53 had constipation predominant, 19 had diarrhea predominant, and 28 had alternating type IBS. Skin prick tests positivity were more common among the IBS patients in comparison with controls (25% and 1%, respectively, P<0.05). Mean IgE values were higher in patients than controls (70.83+/-66.05 and 15.20+/-14.01 IU/mL, respectively, P<0.000). Eosinophilic cationic protein values were also higher in IBS patients than controls (16.75+/-11.28 and 11.56+/-4.72, respectively, P<0.05) Evaluation of Beck Depression Inventory showed that tendency to depression in patients with IBS was 38% and 4% in controls (P<0.05). CONCLUSIONS According to our results, in patients complaining of IBS it is of importance to search for a food component. Clinical improvements can be observed after the introduction of an adequate exclusion diet.
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Affiliation(s)
- Ebru Uz
- Department of Internal Medicine, Fatih University Medical School [corrected] Ankara, Turkey
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Ventura MT, Polimeno L, Amoruso AC, Gatti F, Annoscia E, Marinaro M, Di Leo E, Matino MG, Buquicchio R, Bonini S, Tursi A, Francavilla A. Intestinal permeability in patients with adverse reactions to food. Dig Liver Dis 2006; 38:732-6. [PMID: 16880015 DOI: 10.1016/j.dld.2006.06.012] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 05/24/2006] [Accepted: 06/12/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND An abnormal intestinal permeability could contribute to establish an altered sensitivity to food-allergen. AIM To evaluate the intestinal permeability in subjects with adverse reactions to food on allergen-free diet. SUBJECTS Twenty-one patients with food allergy and 20 with food hypersensitivity on allergen-free diet were enrolled and divided in four groups according to the seriousness of their referred clinical symptoms when they were on a free diet. METHODS Intestinal permeability was evaluated by Lactulose/Mannitol ratio urinary detection determined by anion-exchange chromatography. RESULTS Statistically significant different Lactulose/Mannitol ratio was evidenced in subjects with food allergy (p=0.003) or hypersensitivity (p=0.0008) compared to control patients. The correlation between Lactulose/Mannitol ratio and the seriousness of clinical symptoms, by using Spearman test, was statistically significant for food allergy (p=0.0195) and hypersensitivity (p=0.005) patients. CONCLUSIONS The present data demonstrate that impaired intestinal permeability, measured in our conditions, is present in all subjects with adverse reactions to food. In addition, for the first time, we report a statistically significant association between the severity of referred clinical symptoms and the increasing of Intestinal Permeability Index. These data reveal that intestinal permeability is not strictly dependent on IgE-mediated processes but could better be related to other mechanisms involved in early food sensitisation, as breast-feeding, or microbial environment that influence the development of oral tolerance in early infancy.
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Affiliation(s)
- M T Ventura
- Department of Internal Medicine, Immunology and Infectious Diseases (MIDIM), University of Bari Medical School, Policlinico, Piazza G. Cesare n 11, 70124 Bari, Italy.
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22
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Wang B, Li F, Dong B, Zhang X, Zhang C, Xiang J. Discovery of the genes in response to white spot syndrome virus (WSSV) infection in Fenneropenaeus chinensis through cDNA microarray. MARINE BIOTECHNOLOGY (NEW YORK, N.Y.) 2006; 8:491-500. [PMID: 16794954 DOI: 10.1007/s10126-005-6136-4] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Accepted: 02/09/2006] [Indexed: 05/10/2023]
Abstract
We used microarray technology to study differentially expressed genes in white spot syndrome virus (WSSV)-infected shrimp. A total of 3136 cDNA targets, including 1578 unique genes from a cephalothorax cDNA library and 1536 cDNA clones from reverse and forward suppression subtractive hybridization (SSH) libraries of Fenneropenaeus chinensis, plus 14 negative and 8 blank control clones, were spotted onto a 18 x 18 mm area of NH(2)-modified glass slides. Gene expression patterns in the cephalothorax of shrimp at 6 h after WSSV injection and moribund shrimp naturally infected by WSSV were analyzed. A total of 105 elements on the arrays showed a similar regulation pattern in artificially infected shrimp and naturally infected moribund shrimp; parts of the results were confirmed by semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR). The up-regulated expression of immune-related genes, including heat shock proteins (HSP70 and HSP90), trehalose-phosphate synthase (TPS), ubiquitin C, and so forth, were observed when shrimp were challenged with WSSV. Genes including myosin LC2, ATP synthase A chain, and arginine kinase were found to be down-regulated after WSSV infection. The expression of housekeeping genes such as actin, elongation factor, and tubulin is not stable, and so these genes are not suitable as internal standards for semiquantitative RT-PCR when shrimp are challenged by WSSV. As a substitute, we found that triosephosphate isomerase (TPI) was an ideal candidate of interstandards in this situation.
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Affiliation(s)
- Bing Wang
- Institute of Oceanology, Chinese Academy of Sciences, Qingdao, People's Republic of China
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Abstract
According to the recently revised nomenclature for allergy the term "Food Hypersensitivity" is proposed to define a reaction on food exposure causing objectively reproducible symptoms or signs at a dose tolerated by normal subjects. Those reactions to food in which immunologic mechanisms are demonstrated comprise the term "Food Allergy". Immunologic reactions to food in which an immunoglobulin E (IgE)-mediated mechanism is established are defined as IgE-mediated food allergy. This review focuses on IgE-mediated allergic reactions to foods.
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Affiliation(s)
- Jesús F Crespo
- Servicio de Alergia, Hospital Universitario 12 de Octubre, Madrid, Spain
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24
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Opinion of the Scientific Panel on Dietetic products, nutrition and allergies [NDA] on a request from the Commission relating to the evaluation of allergenic foods for labelling purposes. EFSA J 2004. [DOI: 10.2903/j.efsa.2004.32] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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25
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Figueredo E, Cuesta-Herranz J, De-Miguel J, Lázaro M, Sastre J, Quirce S, Lluch-Bernal M, De las Heras M. Clinical characteristics of melon (Cucumis melo) allergy. Ann Allergy Asthma Immunol 2003; 91:303-8. [PMID: 14533664 DOI: 10.1016/s1081-1206(10)63534-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although melon is a frequent allergy-eliciting fruit, allergic reactions to melon have rarely been reported. OBJECTIVE To evaluate and describe the clinical characteristics of melon allergy in melon-allergic patients. MATERIALS AND METHODS We evaluated patients allergic to melon and a control group of patients allergic to pollen. The diagnosis of melon allergy was based on a convincing clinical history, positive skin test results (prick-by-prick test), and positive results on oral challenge tests to melon. RESULTS A total of 161 patients were included in the study: 66 in the melon allergy group and 95 in the pollen control group. The melon allergy group included 35 female and 31 male patients with a mean age of 26.6 +/- 2.7 years (range, 5-61 years). Although all patients had oral symptoms, 13 (19.7%) of the patients had extraoral symptoms and none experienced generalized urticaria or anaphylaxis. Excluding other Cucurbitaceae fruits, peach, fig, and kiwi most frequently elicited positive skin test results and symptoms. Up to 23% of melon-allergic patients had a concomitant latex sensitization. Melon allergy was especially linked to pollen allergy, since all the melon-allergic patients were also allergic to pollen. Some differential features with respect to the pollen allergy control group were a higher prevalence of asthma (odds ratio [OR], 2.13; P < 0.05) and a statistical increase in the frequency of sensitization to several tree and weed pollens, including Ulmus (OR, 42.8) and Ambrosia (OR, 22.4). CONCLUSION The most important conditions linked to melon allergy are pollen allergy (100%), allergy to other nonrelated fruits, mainly peach (up to 62%), and latex sensitivity (up to 23%). Some differential features of the pollinosis in melon allergy were a higher prevalence of asthma and a higher frequency of sensitization to several weed and tree pollens.
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Affiliation(s)
- J F Crespo
- Servicio de Alergia, Hospital Universitario Doce de Octubre, Madrid, Spain
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Yu CJ, Lin YF, Chiang BL, Chow LP. Proteomics and immunological analysis of a novel shrimp allergen, Pen m 2. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2003; 170:445-53. [PMID: 12496430 DOI: 10.4049/jimmunol.170.1.445] [Citation(s) in RCA: 180] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Shellfish are a common cause of adverse food reactions in hypersensitive individuals and shrimp is one of the most frequently reported causes of allergic reactions. A novel allergen from Penaeus monodon, designated Pen m 2, was identified by two-dimensional immunoblotting using sera from subjects with shrimp allergy, followed by matrix-assisted laser desorption ionization time-of-flight mass spectrometry analysis of the peptide digest. This novel allergen was then cloned and the amino acid sequence deduced from the cDNA sequence. The cloned cDNA encoded a 356-aa protein with an acetylated N terminus at Ala2, identified by postsource decay analysis. Comparison of the Pen m 2 sequence with known protein sequences revealed extensive similarity with arginine kinase (EC 2.7.3.3) from crustaceans. Pen m 2 was purified by anion exchange chromatography and shown to have arginine kinase activity and to react with serum IgE from shrimp allergic patients and induce immediate type skin reactions in sensitized patients. Using Pen m 2-specific antisera and polyclonal sera from shrimp-sensitive subjects in a competitive ELISA inhibition assay, Pen m 2 was identified as a novel cross-reactive Crustacea allergen. This novel allergen could be useful in allergy diagnosis and in the treatment of Crustacea-derived allergic disorders.
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Affiliation(s)
- Chia-Jung Yu
- Institute of Biochemistry and Molecular Biology, College of Medicine, National Taiwan University, Taipei, Taiwan
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28
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Takwale A, Cox J, Selwyn E, Charles-Holmes S. Food allergy diets - a cautionary tale. Clin Exp Dermatol 2002; 27:715-6. [PMID: 12472555 DOI: 10.1046/j.1365-2230.2002.01102_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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29
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Wallaert B, Gosset P, Lamblin C, Garcia G, Perez T, Tonnel AB. Airway neutrophil inflammation in nonasthmatic patients with food allergy. Allergy 2002; 57:405-10. [PMID: 11972479 DOI: 10.1034/j.1398-9995.2002.13527.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with food allergy (FA) have been recently shown to develop bronchial hyperresponsiveness (BHR), despite the absence of any concomitant asthmatic manifestation. In order to explain this observation, we sought to examine the presence of a bronchial inflammation in induced sputum of nonasthmatic patients with FA. METHODS Twelve nonasthmatic patients with FA (urticaria, digestive symptoms, anaphylaxis) were included in the study. Results were compared to these obtained from eight asthmatic patients without food allergy and eight healthy controls. Diagnosis of FA was based on double-blind placebo-controlled challenge. Sputum cells and fluid-phase eosinophil cationic protein (ECP), myeloperoxidase (MPO) and interleukin-8 (IL-8) were measured in induced sputum. BHR was evaluated using methacholine inhalation. RESULTS Sputum from asthmatics, in comparison with the sputum of healthy subjects and patients with FA contained a higher proportion of eosinophils and higher levels of ECP (< 0.001). In marked contrast, patients with FA exhibited an increased proportion of neutrophils and IL-8 in comparison with asthmatics and controls (P < 0.05 for neutrophils and P < 0.001 for IL-8). There was a significant correlation between sputum neutrophils and IL-8 (r = 0.68, P < 0.001). MPO levels were not different between the groups. There was a trend toward higher levels of IL-8 and ECP in food allergic patients with BHR in comparison with patients with FA without BHR. CONCLUSION Our results demonstrate that a subclinical neutrophil airway inflammation is present in patients with food allergy free of clinical respiratory symptoms and that IL-8 may be an important mediator of this neutrophilia.
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Affiliation(s)
- Benoit Wallaert
- Clinique des Maladies Respiratoires, Service de Pneumologie et Immuno-allergologie, Hôpital A. Calmette, CHRU Lille, 59037 Lille Cedex, France
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Baker JC, Duncanson RC, Tunnicliffe WS, Ayres JG. Development of a standardized methodology for double-blind, placebo-controlled food challenge in patients with brittle asthma and perceived food intolerance. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2000; 100:1361-7. [PMID: 11103659 DOI: 10.1016/s0002-8223(00)00382-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To develop a standardized, double-blind, placebo-controlled, food challenge (DBPCFC) methodology for identifying food intolerance in patients with brittle asthma. SUBJECTS/SETTING Patients with brittle asthma and perceived food intolerance were studied in hospital. DESIGN Each of 3 protocols began with 5 days of dietary exclusion. Protocol 1 consisted of open food challenges in 29 patients, protocol 2 consisted of 2 daily DBPCFCs in 22 patients, and protocol 3 involved 1 daily DBPCFC in 18 patients. Total immunoglobulin E level was measured and food-specific radioallergosorbent tests and skin prick tests were conducted. A standard panel of hyperallergenic foods were masked in a soup (developed specially for this study) for every food challenge. Peak expiratory flow, forced expiratory volume, and symptoms were assessed as objective measures of response. Open food challenges at home followed each protocol. Each protocol took approximately 14 days in the hospital and 4 to 6 months at home. RESULTS For protocols 1, 2 and 3, positive reactions were experienced by 52%, 55%, and 66% of patients, respectively. Radioallergosorbent tests and skin prick tests were shown to have 40% and 71% sensitivity, respectively, and 74% and 77% specificity for predicting a positive food challenge. APPLICATIONS/CONCLUSIONS The high prevalence of food intolerance in patients with brittle asthma was confirmed, as was the poor positive predictive value of skin prick tests and radioallergosorbent tests. The food challenge method developed enables standardized identification of food intolerances in patients with brittle asthma and may be useful in other groups.
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Affiliation(s)
- J C Baker
- Brittle Asthma Unit, Birmingham Heartlands Hospital, UK
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31
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Ballmer-Weber BK, Vieths S, Lüttkopf D, Heuschmann P, Wüthrich B. Celery allergy confirmed by double-blind, placebo-controlled food challenge: a clinical study in 32 subjects with a history of adverse reactions to celery root. J Allergy Clin Immunol 2000; 106:373-8. [PMID: 10932083 DOI: 10.1067/mai.2000.107196] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Celery root is a frequent cause of food allergy in pollen-sensitized patients. Because of problems in blinding challenges with fresh vegetables and the risk of anaphylactic reactions, no double-blind, placebo-controlled, food challenges (DBPCFCs) with celery have been published so far. OBJECTIVE The aim of the study was to confirm the clinical relevance of celery as a food allergen by DBPCFCs and to evaluate current diagnostic procedures in patients with true allergy. METHODS DBPCFCs were performed in 32 patients with a history of an allergic reaction to celery. The patients underwent skin prick tests (SPTs) with celery extracts, crude celery, and different pollen extracts. Specific IgE for celery was determined by using the CAP method. RESULTS Twenty-two of 32 patients had a positive DBPCFC result. Two patients reacted to placebo, and 8 patients did not respond to the challenge. Of the nonresponders, 4 reacted to an open provocation with celery. The sensitivity of CAP determination for specific IgE (> or =0.7 kU/L) to celery in patients with a positive DBPCFC result was 73%, 48% to 86% for SPTs (> or =3 mm) with commercial extracts, and 96% for prick-to-prick tests with crude celery. The positive predictive value of the SPT and CAP tests was between 87% and 96%, whereas the specificity and negative predictive values were poor. CONCLUSION This study confirms the importance of celery as a food allergen for use in DBPCFCs. The SPT and CAP methods proved to be reliable for the diagnosis of a relevant allergy to celery in regard to sensitivity and positive predictive value but not to specificity and negative predictive value.
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Affiliation(s)
- B K Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital, Zürich, Switzerland
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32
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Gendeh BS, Murad S, Razi AM, Abdullah N, Mohamed AS, Kadir KA. Skin prick test reactivity to foods in adult Malaysians with rhinitis. Otolaryngol Head Neck Surg 2000; 122:758-62. [PMID: 10793361 DOI: 10.1016/s0194-5998(00)70211-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the study was to determine the incidence of food and house dust mite (HDM) allergy in patients with nasal congestion and rhinorrhea attending the Otorhinolaryngology Clinic, National University of Malaysia, Kuala Lumpur. This was a prospective matched, controlled study of patients skin prick tested with commercial food and common aeroallergens. The participants were 148 Malaysian adults with symptoms of nasal congestion and rhinorrhea and 113 adult Malaysian control subjects without rhinitis symptoms. The skin prick test (SPT) was used to evaluate 11 foods common to the Malaysian diet and 3 HDM inhalants. Forty-eight percent of the patients with rhinitis had positive SPT results to foods, compared with 4.4% of control subjects (P < 0.05). The most commonly implicated foods were shrimp (48%) and rice (30%), which are common in the Malaysian diet. Seventy-two percent of rhinitis patients had positive SPT results to HDM, compared with 22.2% of control subjects (P < 0.05). Patients with rhinitis also had significantly more gastrointestinal problems than control subjects (P < 0.05). The incidences of HDM and food allergy are significantly greater in Malaysian adults with rhinitis symptoms than in control subjects without rhinitis. The effect of avoidance or immunotherapy awaits further study.
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Affiliation(s)
- B S Gendeh
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, National University of Malaysia, Kuala Lumpur
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Gendeh BS, Murad S, Razi AM, Abdullah N, Mohamed AS, Kadir KA. Skin prick test reactivity to foods in adult Malaysians with rhinitis. Otolaryngol Head Neck Surg 2000. [DOI: 10.1067/mhn.2000.100445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of the study was to determine the incidence of food and house dust mite (HDM) allergy in patients with nasal congestion and rhinorrhea attending the Otorhinolaryngology Clinic, National University of Malaysia, Kuala Lumpur. This was a prospective matched, controlled study of patients skin prick tested with commercial food and common aeroallergens. The participants were 148 Malaysian adults with symptoms of nasal congestion and rhinorrhea and 113 adult Malaysian control subjects without rhinitis symptoms. The skin prick test (SPT) was used to evaluate 11 foods common to the Malaysian diet and 3 HDM inhalants. Forty-eight percent of the patients with rhinitis had positive SPT results to foods, compared with 4.4% of control subjects ( P < 0.05). The most commonly implicated foods were shrimp (48%) and rice (30%), which are common in the Malaysian diet. Seventy-two percent of rhinitis patients had positive SPT results to HDM, compared with 22.2% of control subjects ( P < 0.05). Patients with rhinitis also had significantly more gastrointestinal problems than control subjects (P < 0.05). The incidences of HDM and food allergy are significantly greater in Malaysian adults with rhinitis symptoms than in control subjects without rhinitis. The effect of avoidance or immunotherapy awaits further study.
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Affiliation(s)
- Balwant Singh Gendeh
- From the Departments of Otorhinolaryngology–Head and Neck Surgery (Drs Gendeh and Sani)
| | - Shahnaz Murad
- the Division of Immunology, Institute for Medical Research (Drs Shahnaz, Azizah, and Nasaruddin)
| | - Azizah Mohd Razi
- the Division of Immunology, Institute for Medical Research (Drs Shahnaz, Azizah, and Nasaruddin)
| | - Nasaruddin Abdullah
- the Division of Immunology, Institute for Medical Research (Drs Shahnaz, Azizah, and Nasaruddin)
| | - Abdullah Sani Mohamed
- From the Departments of Otorhinolaryngology–Head and Neck Surgery (Drs Gendeh and Sani)
| | - Khalid Abdul Kadir
- Medicine (Dr Khalid), Faculty of Medicine, National University of Malaysia
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Abstract
During the past 25 years the diagnostic assessment of IgE-associated food hypersensitivity has improved substantially. The double-blind placebo-controlled food challenge has become the "gold-standard" against which all other diagnostic approaches can be measured. Having a standard which gives a correct answer almost all of the time, has enabled us to move to more accurate diagnoses in both the clinic and the laboratory. Food allergy has gone from being a medical mystery to being a clear component of allergy evaluation. Histories are obtained from patients which may be used to design food challenges. The role of skin testing and its interpretation has moved from the fringe to having a central role in eliminating foods incriminated as causes of immediate-onset allergic reactions. The material used for skin testing for foods has improved and we have learned when we must use fresh substances to supplement the commercial extracts. Recently the CAP radioallergosorbent test has shown promise in raising the probability of food reactions to the point that for a few foods in specific individuals, challenges may not be needed. Progress in this area will continue. We have been able to clarify which foods have a high probability of producing symptoms and which foods and which constellation of complaints are unlikely to be confirmed. These patterns of food allergic reactions have now been reproduced in many research centers throughout the world giving us confidence in their validity.
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Affiliation(s)
- S A Bock
- Department of Pediatrics, National Jewish and Medical Research Center, University of Colorado Health Sciences Center, Denver, USA
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Helbling A, Haydel R, McCants ML, Musmand JJ, El-Dahr J, Lehrer SB. Fish allergy: is cross-reactivity among fish species relevant? Double-blind placebo-controlled food challenge studies of fish allergic adults. Ann Allergy Asthma Immunol 1999; 83:517-23. [PMID: 10619342 DOI: 10.1016/s1081-1206(10)62862-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Allergic reactions to fish are a common cause of food allergy in many areas of the world where fish is a major source of protein. Although different species of fish may be consumed, possible cross-reactivity has received limited investigation. OBJECTIVE The aim of this study was to assess potential cross-reactivity to different species of fish species using double-blind, placebo-controlled food challenges (DBPCFC) in fish-allergic adults and to compare skin test and RAST reactivity with the challenge response. METHODS Nine skin prick test and/or RAST-positive adult individuals with histories of an immediate-type reaction following fish ingestion were challenged with different fish species using double-blind, placebo-controlled food challenge. RESULTS Of a total of 19 double-blind, placebo-controlled fish challenges performed, 14 challenges (74%) resulted in the induction of objective signs that were consistent with an IgE-mediated response. The most common sign observed was emesis (37%); the most prevalent subjective symptoms reported were compatible with the oral allergy syndrome (84%). Three subjects reacted to at least three fish species and one subject reacted to two fish species tested. In regard to the positive challenges, predictive accuracy of skin prick test and RAST was 84% and 78%, respectively. CONCLUSION Our results indicate that clinically relevant cross-reactivity among various species of fish may exist. Advising fish-allergic subjects to avoid all fish species should be emphasized until a species can be proven safe to eat by provocative challenge.
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Affiliation(s)
- A Helbling
- Institute of Allergology and Immunology, University Hospital, Bern, Switzerland
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36
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Abstract
Patients with food-induced allergic disorders may be first seen with a variety of symptoms affecting the skin, respiratory tract, gastrointestinal tract, and/or cardiovascular system. The skin and respiratory tract are most often affected by IgE-mediated food-induced allergic reactions, whereas isolated gastrointestinal disorders are most often caused by non-IgE-mediated reactions. When evaluating possible food-induced allergic disorders, it is often useful to categorize disorders into IgE- and non-IgE-mediated syndromes. The initial history and physical examination are essentially identical for IgE- and non-IgE-mediated disorders, but the subsequent evaluation differs substantially. Proper diagnoses often require screening tests for evidence of food-specific IgE and proof of reactivity through elimination diets and oral food challenges. Once properly diagnosed, strict avoidance of the implicated food or foods is the only proven form of treatment. Clinical tolerance to food allergens will develop in many patients over time, and therefore follow-up food challenges are often indicated. However, a number of novel immunomodulatory strategies are in the developmental stage and should provide more definitive treatment for some of these food-induced allergic disorders in the next several years.
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Affiliation(s)
- H A Sampson
- Jaffe Food Allergy Institute, The Mount Sinai School of Medicine, New York, USA
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37
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Abstract
The skin is the most frequently affected target organ in allergy or intolerance of food and food additives. The most common manifestation is acute urticaria (with or without angioedema), accounting for 40-60% of patients with IgE-mediated food allergy, whereas food additives rather aggravate chronic urticaria (intolerance provocation). The role of food allergy in the pathogenesis of atopic dermatitis is still controversial; however, there is no doubt that, particularly in infants and young children, food allergens can induce atopic dermatitis or aggravate skin lesions. In adults, food allergy as a cause or a trigger of atopic dermatitis is very rare. However, in food-allergic patients with atopic dermatitis, the ingestion of the food item can provoke the whole spectrum of IgE-mediated symptoms, from oral allergy syndrome to severe anaphylaxis. Skin symptoms can also be induced not only after food ingestion in sensitized people, but also after direct skin contact, as lipophilic food allergens can penetrate the skin via the hair follicles or when the skin barrier function is defective. Immediate contact reactions of the skin are a heterogeneous group: they include not only contact urticaria (contact urticaria syndrome) on an immunologic or nonimmunologic basis, but also allergic or nonallergic eczematous reactions caused by food proteins (protein contact dermatitis). A prototype is baker's eczema in a restricted sense with immediate-type sensitization to flour. Atopic eczema provoked by direct contact of the skin with food must also be taken into consideration. Finally, very rarely, allergic contact dermatitis that is due to type IV sensitization to food or food additives (positive delayed type reaction in the patch tests) can occur. The oral ingestion of these foods may provoke in these patients a generalized eczematous rash or dyshidrosiform reactions (vesicles) of the fingers, palms, and soles.
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Affiliation(s)
- B Wüthrich
- Department of Dermatology, University Hospital, Zurich, Switzerland
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Cuesta-Herranz J, Lázaro M, de las Heras M, Lluch M, Figueredo E, Umpierrez A, Hernandez J, Cuesta C. Peach allergy pattern: experience in 70 patients. Allergy 1998; 53:78-82. [PMID: 9491233 DOI: 10.1111/j.1398-9995.1998.tb03777.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We report the clinical characteristics of peach allergy encountered in a population of peach-allergic patients. We evaluated 165 patients. The 70 peach-allergic patients were diagnosed through clinical history, the skin prick-prick test, and open oral challenge and rub tests to peach. As a pollinic control group, 95 pollen-allergic patients were also evaluated. Some 49% of the patients were male and 51% female. The mean age was 20 +/- 8 years. Oral allergy syndrome (86%) was the most common symptom, followed by contact urticaria (61%) and systemic symptoms (26%). Some 67% of the patients were allergic to peach pulp and 36% reported symptoms related to canned peach. Canned peach and pulp symptoms were statistically associated (P < 0.01), and symptoms to canned peach were more frequently reported by patients with systemic symptoms (P < 0.05). On evaluation of the peach-allergic patients' characteristics, three risk factors--allergy to peach pulp, allergy to canned peach, and peach allergy in non-pollen-allergic patients--were found, indicating development of systemic symptoms on eating peach. Most of the peach-allergic patients (81%) also had pollen allergy, which was linked to a higher prevalence of asthma (73%) than in the pollen-allergic patients of the control group (48%); this difference was statistically significant (P < 0.01). Finally, two groups were clearly defined by the seriousness of the peach allergy--the non-pollen-allergic patients were more predisposed to the occurrence of systemic symptoms (> 50%), and the pollen-allergic patients to asthma (> 70%).
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Rancé F, Juchet A, Brémont F, Dutau G. Correlations between skin prick tests using commercial extracts and fresh foods, specific IgE, and food challenges. Allergy 1997; 52:1031-5. [PMID: 9360758 DOI: 10.1111/j.1398-9995.1997.tb02427.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The skin prick test is the most widely used test for detecting IgE-mediated food hypersensitivity. Our study aimed to define firstly the correlations between results obtained with prick tests using commercial extracts and fresh foods, and secondly the correlations between these results and those obtained with labial and/or oral challenge. We compared the wheal diameters read at 15 min with commercial extracts and fresh foods, for four foods, in 430 children with suspected food allergy. For cow's milk, wheal diameters were larger with commercial extracts, but the difference was not significant. Conversely, wheal diameters were significantly larger with fresh foods for the other food allergens. Skin prick tests were positive in 40% of cases with commercial extracts and in 81.3% with fresh foods. The overall concordance between a positive prick test and positive challenge was 58.8% with commercial extracts and 91.7% with fresh foods. These results indicate that fresh foods may be more effective for detecting the sensitivity to food allergens. Fresh foods should be used for primary testing for egg, peanut, and cow's milk sensitivity.
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Affiliation(s)
- F Rancé
- Department of Respiratory and Allergic Diseases in Children and Adolescents, University Hospital Purpan, Toulouse, France
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Hansen TK, Bindslev-Jensen C, Skov PS, Poulsen LK. Codfish allergy in adults. Specific tests for IgE and histamine release vs double-blind, placebo-controlled challenges. Clin Exp Allergy 1996; 26:1276-85. [PMID: 8955577 DOI: 10.1111/j.1365-2222.1996.tb00525.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND At present, several in vitro tests for immunoglobulin E (IgE)-mediated food allergy are available. An estimation of the diagnostic accuracy of the various tests used in predicting clinical sensitivity to codfish in a well-characterized allergic material is necessary. OBJECTIVES To compare the diagnostic value of four specific IgE tests, and histamine release from basophils (HR) in identifying clinical type I allergy to codfish. As a true diagnosis, double-blind, placebo-controlled food challenges (DBPCFC) were employed. METHODS Eight clinically codfish-allergic adult patients were investigated together with 30 codfish-tolerant control subjects for evidence of codfish-specific reactivity by Phadebas RAST (PHA), Pharmacia CAP System RAST (CAP), Magic Lite (ML) and HR. To characterize the diagnostic properties of a freshly prepared raw codfish extract, experiments were conducted employing an in-house radioallergosorbent test (RAST), the Maxisorp RAST (MAXI) and HR. Finally, protein profile and IgE-reacting allergens were detected by means of sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting. RESULTS The sensitivities of HR with commercial extract and the three commercially available specific IgE analyses were 0.83 and 1.00 respectively. Specificities were 1.00 (HR) and 0.87-1.00 (specific IgE tests). Freshly prepared codfish extracts improved the sensitivity of HR. SDS-PAGE revealed approximately 29 bands (< 14.3-200 kDa) including a band of 12-13 kDa, and in immunoblotting 18 sera identified 17 IgE-binding bands. The protein migrating at 12-13 kDa was identified in the fresh codfish extract tested with sera from all clinical codfish allergics, while no significant reaction was seen in the control subjects. CONCLUSION Based on the small number of adult patients included in our study, the in vitro assays with commercial and fresh extracts have high sensitivity and are acceptable for screening for codfish allergy. Specificity of Phadebas, CAP, and our in-house RAST was less than unity, whereas ML and strong binding of IgE to a 12-13 kDa protein completely matches DBPCFC results, and thus seems sufficient for establishing the diagnosis.
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Affiliation(s)
- T K Hansen
- Food Allergy Unit, National University Hospital, Copenhagen, Denmark
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Bengtsson U, Nilsson-Balknäs U, Hanson LA, Ahlstedt S. Double blind, placebo controlled food reactions do not correlate to IgE allergy in the diagnosis of staple food related gastrointestinal symptoms. Gut 1996; 39:130-5. [PMID: 8881824 PMCID: PMC1383246 DOI: 10.1136/gut.39.1.130] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The mechanisms for adverse reactions to foods in the gastrointestinal tract are poorly understood. There is conflicting evidence in the literature on the role for IgE mediated allergy in gastrointestinal reactions to staple foods. AIM The aim was therefore to study the role of IgE mediated allergy in a group of patients with a history of gastrointestinal symptoms related to staple foods (cows' milk, hens' egg, wheat and rye flour) verified in double blind placebo controlled challenges (DBPCFC). PATIENTS Fifteen patients with DBPCFC, identified by screening of 96 consecutive patients referred to our allergy clinic for investigation of suspected gastrointestinal symptoms due to staple foods. METHODS The screening included diaries as well as elimination diets and open and blinded food challenges. The frequency of atopy were compared between the double blind positive and double blind negative patients. RESULTS The positive DBPCFC in the 15 patients included eight patients with milk intolerance, four with wheat flour, two with egg, and one with rye flour. There was no indications of an allergic pathogenesis in all 15 patients with positive DBPCFC, as the skin prick test and radioallergosorbent test were negative for the relevant allergens. The frequency of atopy was four of 21 (19%) in the double blind negative group and three of 15 (20%) in the double blind positive group. CONCLUSION In adult patients with staple food induced gastrointestinal symptoms, objectively verified by DBPCFC, there were no indications of IgE mediated allergy to the relevant foods suggesting other mechanisms in adults than in children. Future studies may include measures of local events in the shock organs in relation to food intake, for instance utilising inflammatory markers in jejunal fluids.
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Affiliation(s)
- U Bengtsson
- Allergy Centre, University of Goteborg, Sweden
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Bruijnzeel-Koomen C, Ortolani C, Aas K, Bindslev-Jensen C, Björkstén B, Moneret-Vautrin D, Wüthrich B. Adverse reactions to food. European Academy of Allergology and Clinical Immunology Subcommittee. Allergy 1995; 50:623-35. [PMID: 7503398 DOI: 10.1111/j.1398-9995.1995.tb02579.x] [Citation(s) in RCA: 388] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- C Bruijnzeel-Koomen
- Department of Allergology, Ospedale Niguarda Piazza Ospedale, Maggiore 3, Milan, Italy
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Norgaard A, Bindslev-Jensen C, Skov PS, Poulsen LK. Specific serum IgE in the diagnosis of egg and milk allergy in adults. Allergy 1995; 50:636-47. [PMID: 7503399 DOI: 10.1111/j.1398-9995.1995.tb02580.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Levels of specific serum IgE to cow's milk, whole hen's egg, egg white, and egg yolk were compared to the outcome of double-blind, placebo-controlled food challenge (DBPCFC) with fresh egg and/or milk in 21 adults with a case history of immediate hypersensitivity to egg and/or milk. Specific serum IgE was measured by four different commercially available tests and by an inhouse Maxisorp RAST using freshly prepared food extracts. Sensitivities and negative predictive accuracies were generally high with egg white and milk, but low with egg yolk. Specificities and positive predictive accuracies were low for all allergens and tests. Changing the cutoff levels did not improve the ability of the tests to predict clinical allergy. Among commercially available test allergens, egg white gave the most consistent results in levels and class scores, and the highest degree of concordance with DBPCFC, whereas egg yolk and milk varied more. Applying freshly prepared food extracts in Maxisorp RAST did not improve diagnostic value. Measuring specific serum IgE levels in control subjects tolerant to egg/milk showed that false positive reactions occurred frequently among patients with another food allergy and atopic dermatitis, whereas most tests were likely to be negative in pollen-allergic and nonallergic volunteers. In conclusion, specific IgE measurements with egg white and milk were useful for exclusion of symptomatic hypersensitivity to egg and milk in patients with a positive history, whereas DBPCFC is still mandatory in patients with positive history and positive test. Measuring egg-yolk-specific IgE or using freshly prepared food extracts for specific IgE measurements added no further diagnostic information. The rate of clinically insignificant positive test results seems to be influenced by the prevalence of other food allergies and/or atopic dermatitis in the population under study.
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Affiliation(s)
- A Norgaard
- Food Allergy Unit, National University Hospital, Copenhagen, Denmark
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Affiliation(s)
- C Loza
- Department of Immunology, University College London Medical School, UK
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Abstract
Protein contact dermatitis is a dermatosis which usually presents as a chronic eczema with episodic acute exacerbations a few minutes after contact with the offending allergen. Patch tests with the responsible allergen are usually negative, and the diagnosis can only be made by means of scratch or prick tests with the allergen. Sometimes, specific IgE antibodies can be detected in the blood. As there is considerable confusion about this entity, we have reviewed the cases reported in the literature.
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Affiliation(s)
- V Janssens
- Department of Medical Research (Dermatology), University Hospital, Katholieke Universiteit Leuven, Belgium
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Jansen JJ, Kardinaal AF, Huijbers G, Vlieg-Boerstra BJ, Martens BP, Ockhuizen T. Prevalence of food allergy and intolerance in the adult Dutch population. J Allergy Clin Immunol 1994; 93:446-56. [PMID: 8120272 DOI: 10.1016/0091-6749(94)90353-0] [Citation(s) in RCA: 255] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The prevalence of food allergy and intolerance (FA/FI) was studied in a random sample (n = 1483) of the Dutch adult population. First, the self-reported FA/FI reactions were investigated by questionnaire. Subsequently, in a clinical follow-up study, it was determined in how many cases this self-reported FA/FI could be objectively confirmed by double-blind placebo-controlled food challenge. More than 10% of the population (12.4%) reported FA/FI to specific food(s). Of the 144 subjects potentially available for the clinical follow-up study, 73 completed the whole protocol. In 12 subjects FA/FI could be confirmed by double-blind placebo-controlled food challenge. This indicates a minimum prevalence of FA/FI in the population of 0.8% (12 of 1483). Assuming that FA/FI is equal among participants, nonparticipants, and dropouts, the prevalence of FA/FI in the Dutch adult population is estimated to be 2.4%. The food (ingredients) involved included pork, white wine, and menthol. Two persons reacted to additives. In three persons glucose intolerance was observed. However, these specific intolerances probably do not reflect the distribution in the general population because the study population formed an extremely heterogeneous group, both with regard to the offending foods and the symptoms. The majority of the subjects had no serious complaints that required medical advice. We conclude that there is a gap between self-reported FA/FI and FA/FI that can be objectively confirmed by double-blind placebo-controlled food challenge.
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Affiliation(s)
- J J Jansen
- Department of Human Nutrition, Netherlands Organization for Applied Scientific Research Toxicology and Nutrition Institute, Zeist
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Kivity S, Dunner K, Marian Y. The pattern of food hypersensitivity in patients with onset after 10 years of age. Clin Exp Allergy 1994; 24:19-22. [PMID: 8156440 DOI: 10.1111/j.1365-2222.1994.tb00911.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
One hundred and twelve patients with a history of immediate adverse reaction after food ingestion and positive skin test to food are presented with the result of food challenge. In all patients the symptoms started after 10 years of age; most presented with recurrent short-lasting urticarial rash, often accompanied by rhinitis. In the majority of the patients, skin tests were positive to multiple food allergens, but 67% of these responded to oral provocation by only one allergen. One-third of the patients had a history of allergic symptoms following exercise after meals, but in only one-third of these symptoms were reproducible in the laboratory. Fruit and vegetables were the main allergens responsible for food hypersensitivity. Food allergy can develop after the first 10 years of life. Fruit and vegetables are the main cause of food allergy in these patients, while milk and egg are the least common. These findings differ from those in early childhood where milk and eggs are the main allergens.
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Affiliation(s)
- S Kivity
- Department of Pulmonary and Allergic Diseases, Tel-Aviv Sourasky Medical Center, Israel
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Affiliation(s)
- J J Musmand
- Tulane University School of Medicine, Department of Medicine, New Orleans, Louisiana 70112, USA
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